SHERIDAN — Within mainstream society in the United States, women giving birth at home is often regarded odd. However, for most of human history, pregnancy and labor were not regarded as a medical emergency warranting the immediate care of a physician. Instead, the process was viewed from the paradigm that it is a natural rite of passage that, while challenging, rarely becomes a medical emergency.
A recent landmark study in the Journal of Midwifery and Women’s Health, a peer-reviewed publication, followed approximately 17,000 home births and found low-risk home births resulted in low rates of interventions without any increased risk of adverse outcomes for mothers and babies.
One of the major arguments that has created a recent surge in demand for midwifery services is the growing rate of cesarian sections performed in the United States.
The World Health Organization asserts the best outcomes for mothers and babies appear to occur when c-section rates are between 5 and 10 percent. In 1965, when it was first measured, the rate of c-section deliveries in the United States was 4.5 percent. With the progression of medicine and cultural norms, that rate rose through the decades to today’s national average of 33 percent.
In other words, 1 out of 3 U.S. women now birth children via surgery.
At Sheridan Memorial Hospital, the c-section rate in 2012 was 26 percent, and in 2013, 27 percent.
Registered Nurse at the SMH Women’s Health Clinic Linda Schwabauer said common reasons c-sections are performed are because of fetal distress, failure to progress in labor, a “breech,” or feet-first, presentation of the baby, having twins or having had a c-section previously.
Because SMH does not have a 24-hour obstetrician and anesthesiologist at the facility, the hospital does not offer the option of vaginal births to mothers who have had previous cesarians. Ironically, Wyoming law does allow midwives to attend Vaginal Births After Cesarian deliveries.
“I feel we do an appropriate amount of c-sections,” Schwabauer said. “We don’t perform elective c-sections for parents just for convenience.”
Schwabauer pointed to the imminent uncertainty of childbearing as a situation that calls for physician supervision.
“I’m not for home deliveries at all,” she said. “We have very skilled, qualified physicians that have gone to school to become what they are. You never know when a patient is going to require immediate, emergent need. If I had a crystal ball to see which ones would require emergent care, that would be great.”
Schwabauer credited SMH’s trained medical staff with the facility’s track record of low mortality for mothers and babies.
Statistics provided by Unit Clerk Sue Bohm compiled between 2007 and 2013 indicate roughly 1 out of 124 babies were stillborn at SMH. The stillbirth average across the U.S. is roughly 1 out of 160, according to March of Dimes.
Data regarding maternal mortality was not immediately available.
Licensed Midwife Pat Schwaiger, who is based in Montana but was instrumental in licensing midwives in Wyoming, counters that often, the medical interventions used to induce and progress labor are the same factors that contribute to fetal distress or failure to progress, which ultimately create a situation where c-sections become necessary.
“Everybody wants to have a perfect child, and nobody wants to be sued,” Schwaiger said. “At the end of the day, if a doctor has done a c-section, he can say he has done everything he possibly could.”
However, commonly cited reasons for the high rate of cesarian deliveries in the U.S. aren’t time constraints of physicians or declining health of the mother. Instead, the National Partnership for Women and Families attributes the phenomenon to the low priority of empowering women to make informed choices regarding birthing, side effects of common interventions and procedural efficiency.
The availability of immediate, critical care available in a hospital setting is one of the major draws of a hospital birth, and evidence suggests a birth setting closer to emergent care abilities is immediately tied to successful outcomes for babies.
In February, researchers at Cornell University concluded the risk of a baby dying is nearly four times higher when delivered by a midwife at home than by a midwife in a hospital. In some parts of the nation, midwives deliver infants in hospitals, but Sheridan women are faced with a blunt choice of delivering in a hospital with a physician or at home with a midwife.